Exploring the effectiveness of physical health check interventions for people with severe mental illness: a systematic review of qualitative and quantitative evidence.

Abstract

BACKGROUND: People living with severe mental illness (SMI) have a life expectancy up to twenty years shorter than the general population. Among the causes for this health inequity is the increased risk of cardiovascular and metabolic conditions. Physical health checks were introduced to proactively care for the physical health of people with SMI. However, uptake to health checks in the United Kingdom are suboptimal and health inequities remain. The effectiveness of interventions on outcomes of physical health checks has yet to be properly examined, along with what supports or hinders their implementation. This review aimed to assess the effectiveness of health check interventions for changing physical health markers in the SMI population. METHODS: Studies examining the impact of outpatient and community interventions on cardiovascular and metabolic health markers of adults with SMI were collated. Five databases were searched (Web of Science, CENTRAL, PsychInfo, SCOPUS, Medline). The Mixed Methods Appraisal Tool critically appraised studies and analysis followed the Joanna Briggs Institute Convergent Segregated approach to Mixed-Methods Systematic Reviews. RESULTS: Eight articles (7 quantitative, 1 qualitative), totalling 1,828 participants, were included. Five found significantly positive effects on primary outcome(s). Successful studies improved health checks by integrating an extra layer of care (i.e. additional multidisciplinary teams) to existing services, whereas unsuccessful ones looked to improve checks within existing services. However, no marker was significantly improved across a majority of interventions. Four studies addressed barriers/facilitators to implementation success, revealing five themes. CONCLUSIONS: Current evidence is limited for understanding effective interventions on physical health checks, due to inconsistent core outcomes and reporting of interventions. Knowledge of implementation is significantly limited. The difference in outcomes across implementation strategies suggests a focus on equity over quality might be beneficial in the short-term. No studies embedded co-production within the development of physical health check interventions, highlighting a priority area for future research. TRIAL REGISTRATION: https://doi.org/10.17605/OSF.IO/UWC2M .